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PRESCRIBING INFORMATION


CONTACT US

Phone Number (800) 44-BOTOX, Option 4

Monday through Friday
9:00am- 8:00pm ET
Address
Botox®
PO Box 220350 
Charlotte, NC 28222-0350

Your Provider Resource Center for Service and Information Relating to BOTOX® Reimbursement
Click here to see Important Information about Botox (onabotulinumtoxinA)

TERMS OF USE

Welcome to BOTOXreimbursementsolutions.com (the “Site”), a website for clearinghouse services arranged by Allergan, Inc. (“Allergan”) and administered and operated by The Lash Group, Inc. (“Lash”) and other third party vendors of Allergan. Lash provides the clearinghouse services directly to you. The Site contains information about BOTOX®, a product of Allergan. Access to and use of the Site are subject to the following terms and conditions and all applicable laws (collectively, “Terms of Use”). If you do not agree with the Terms of Use, please do not use the Site. As the Terms of Use may be revised from time to time, you should review them periodically. Furthermore, by using the Site you agree to execute any and all documents that are necessary to make use of the Site, and the services offered through the Site, available to you. By using the Site, you are indicating that you are at least eighteen (18) years old and have the legal authority to accept the Terms of Use. This is a legally binding agreement that sets forth our entire agreement and supersedes any conflicting terms in any other agreement between the parties with respect to the use of the Site, including the information collected through the Site.


Services

The Site performs certain clearinghouse services exclusively for those providers who use BOTOX®, by serving to electronically verify insurance eligibility and research claims statuses of BOTOX® with payers. In addition, the Site processes BOTOX® claim status requests containing a nonstandard format or containing nonstandard data content (specifically Direct Data Entry) into standard transactions. The Site does not route or store any information related to other non-BOTOX® related insurance eligibility, claim statuses or other services beyond what is needed to extract the BOTOX®-related information from data submitted by the provider and to perform the services offered through the Site.

In addition to insurance benefit and claim status research, the Site provides participating providers with additional coding and billing information regarding BOTOX® to support the appropriate submission of a BOTOX® claim. These services may be referred to collectively in the Terms of Use as the "e-Patient Management Services."


Access to Password-Protected Areas

Portions of the Site are password-protected ("Password Protected Areas"). To be eligible to access the Password Protected Areas, you must be a physician or staff member of a physician office that has received a login and password information from the Site. The login and password are for your personal use only and are not transferable. You may not share your login or password with any other individual. You agree that you will be responsible for maintaining your password as confidential and for any activity that occurs as a result of your enabling or permitting another person or entity to use your password. You agree to immediately notify Allergan by one of the methods listed in these Terms of Use in the event that (i) your password is lost or stolen, or (ii) you become aware of any unauthorized use of your password or of any other breach of security related to the Password-Protected Areas. Neither Allergan nor Lash is responsible for any loss or damage arising from your failure to comply with the provisions of this section.


Compliance with Laws

You may not use the Site for any purpose or in any manner that violates any applicable local, state, or federal law or regulation or the law or regulation of any foreign government. You represent and warrant that you have all rights to post and/or submit any data or information through the Site (collectively, "Data"). You agree that you will only submit Data in compliance with the Health Information Portability and Accountability Act of 1996 ("HIPAA"), as amended by, among other authorities, the Health Information Technology for Economic and Clinical Health Act (the "HITECH Act"), and their implementing requlations, and other applicable state or federal privacy laws. You agree that, to the extent required and/or appropriate, you are responsible for obtaining any authorizations, informed consents, and/or other required approvals prior to submitting Data to the Site, and, upon Allergan's request, you agree to present redacted copies of the same to Allergan.


Prohibited Behavior

You are responsible for all Data that you upload, post, email or otherwise transmit using the Site. You agree not to use the Site to:

  • Upload, post, email, or otherwise transmit any Data that infringes any patent, trademark, trade secret, copyright or other intellectual property right, privacy right, or publicity right of any person or entity;
  • Directly or indirectly, intentionally disrupt or interfere with the Site or services in any manner that may materially adversely affect Allergan, Lash or any third party; or
  • Upload, post, email or otherwise transmit any material that contains software viruses or any other code, files or programs designed or known to disable, interrupt, or limit the functionality of any computer hardware, computer software, or telecommunications equipment or facilities.


Limitations

Some payers may not be able to accept HIPAA-compliant transactions or may require additional data elements beyond what is required by law and regulations. Additionally, some payers may not have the ability to electronically provide insurance benefit or claims status information. Because the actions of third parties are beyond our control, it is not the responsibility of Allergan or Lash to provide insurance benefit or claims status information from all payers or to ensure the accuracy of the information provided.

The use of the Site does not replace or supplant any existing or future clearinghouse relationships that you or your practice may have. You are solely responsible for ensuring that your use of the Site does not delay, interrupt, interfere, impact or otherwise alter any existing clearinghouse claims routing or other electronic transactions that occur between you and such other clearinghouses. You agree to that Allergan, Lash, other third party service providers, and our respective affiliates, officers, directors, employees and agents, shall not be responsible or be held liable for any delays, interruptions or other errors that may occur or arise out of any claims, reimbursement, payment or other electronic transactions between you and such other clearinghouses.

The use of the Site does NOT promise or guarantee coverage, payment or reimbursement, in whole or in part, of a claim by a payer or other third parties. You agree that you accept responsibility for all applicable claims and for your use of the Site. Please consult your payer organization with regard to local or actual coverage and reimbursement policies and determination processes.


Copyrights

You should assume that all contents of the Site are copyrighted unless otherwise noted and may not be used except as provided herein and without the express written permission of Allergan. Except as expressly provided above, nothing contained herein shall be construed as conferring any license or right under any Allergan copyright.


Trademarks

All product names, logos, and service marks displayed on the Site that are identified by ® or TM or appearing in type form different from that of the surrounding text (collectively, the "Trademarks") are registered or unregistered trademarks owned by or licensed to Allergan or our affiliates, unless otherwise identified as being owned by another entity. Nothing contained herein shall be construed as conferring by implication, estoppel, or otherwise any license or right, either express or implied, under any patent or Trademark of Allergan or any third party. No use of any Trademark may be made without the prior written authorization of Allergan, except to identify the product or services of the company.


User Responsibility

Each person assumes full responsibility and all risks arising from use of the Site. IN NO EVENT SHALL ANY OF ALLERGAN, LASH, OUR RESPECTIVE AFFILIATES, AND ANY OF OUR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, REPRESENTATIVES, INFORMATION PROVIDERS, AND LICENSORS AND THEIR RESPECTIVE HEIRS AND ASSIGNS, BE LIABLE FOR ANY DAMAGES OF ANY KIND OR NATURE, INCLUDING, BUT NOT LIMITED TO, DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL, EXEMPLARY, SPECIAL (INCLUDING LOSS OF PROFIT), PUNITIVE, OR OTHER DAMAGES ARISING FROM OR IN CONNECTION WITH THE EXISTENCE OR USE OF THE SITE, REGARDLESS OF WHETHER ALLERGAN, LASH OR ANY OF THE OTHER ENTITIES OR PERSONS LISTED ABOVE HAS BEEN ADVISED AS TO THE POSSIBILITY OF SUCH DAMAGES. THIS INCLUDES DAMAGES TO, OR FOR VIRUSES THAT MAY INFECT, YOUR COMPUTER EQUIPMENT. WITHOUT LIMITING THE FOREGOING, EVERYTHING ON THE SITE IS PROVIDED TO YOU "AS IS" AND "AS AVAILABLE" BASIS, AND ALLERGAN AND LASH MAKE NO REPRESENTATIONS OR WARRANTIES OF ANY KIND OR NATURE WITH RESPECT TO THE SITE. ALLERGAN AND LASH HEREBY DISCLAIM ALL REPRESENTATIONS AND WARRANTIES, WHETHER EXPRESS OR IMPLIED, CREATED BY LAW, CONTRACT OR OTHERWISE, INCLUDING, BUT NOT LIMITED TO, ANY WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, OR NON-INFRINGEMENT. ALLERGAN AND LASH MAKE NO WARRANTY THAT THE SITE WILL MEET YOUR REQUIREMENTS, OR WILL BE UNINTERRUPTED, TIMELY, SECURE, CURRENT, ACCURATE, COMPLETE OR ERROR-FREE OR THAT THE RESULTS THAT MAY BE OBTAINED BY USE OF THE SITE WILL BE ACCURATE OR RELIABLE. IN ADDITION, NEITHER ALLERGAN OR LASH MAKE ANY WARRANTY WITH RESPECT TO THE INTEROPERABILITY OF ANY SYSTEM WITH THE SITE, INCLUDING, WITHOUT LIMITATION, ANY SYSTEM USED BY YOU OR ANY PAYER, WHETHER PROVIDED BY A THIRD PARTY LICENSOR OR OTHERWISE. Please note that some jurisdictions may not allow the exclusion of implied warranties, so some of the above exclusions may not apply to you. Check your local laws for any restrictions or limitations regarding the exclusion of implied warranties. YOU UNDERSTAND AND ACKNOWLEDGE THAT YOUR SOLE AND EXCLUSIVE REMEDY WITH RESPECT TO ANY DEFECT IN OR DISSATISFACTION WITH THE SITE IS TO CEASE TO USE THE SITE. YOU MAY HAVE OTHER RIGHTS WHICH MAY VARY FROM STATE TO STATE.


Medical Advice

No information in the Site is provided with the intention to give medical advice or instructions on the accurate use of Allergan products. Allergan cannot answer e-mails or other correspondence requesting personal medical advice.


Compliance with HIPAA and the HITECH Act

The Site serves as a portal by which Lash performs services as a health care clearinghouse as defined under HIPAA. Allergan is not a health care clearinghouse and all health care clearinghouse services are provided directly by Lash (or other third parties through Lash). Allergan does not provide any of the e-Patient Management Services. The Site may collect, use and disclose de-identified health claims data and create de-identified data from identifiable data for aggregated and statistical purposes.

To the extent you are a covered entity under HIPAA and provide PHI to Lash to perform the e-Patient Management Services, Lash may be a business associate of yours, and thus the following terms are applicable:

All capitalized terms used in this section of these Terms of Use have the meanings ascribed to them in HIPAA or the HITECH Act. Permitted Uses and Disclosures of PHI by Lash.

Except as otherwise specified herein, Lash may make any and all uses and disclosures of PHI necessary to perform its obligations under these Terms of Use. All other uses and disclosures not authorized by these Terms of Use are prohibited.

Unless otherwise limited herein, Lash may, consistent with applicable laws:

  • Use the PHI in its possession if necessary (i) for its proper management and administration and/or (ii) to carry out any present or future legal responsibilities of Lash provided that such uses are permitted under state and federal confidentiality laws.
  • Disclose the PHI in its possession to third parties for the purpose of its proper management and administration and/or to carry out any present or future legal responsibilities of Lash, provided that that (i) the disclosures are Required by Law; or (ii) Lash has received from the third party written assurances regarding its confidential handling of such PHI as required under HIPAA, and the third party notifies Lash of any breaches in the confidentiality of the PHI.

In addition to using and disclosing the PHI to perform the e-Patient Management Services and the purposes above, Lash may:

  • De-identify PHI provided such de-identification conforms with applicable laws. Such de-identified information is not considered PHI and is not subject to the terms of these Terms of Use.
  • Use and/or disclose PHI to report violations of law to appropriate federal and state authorities, consistent with applicable laws.

Privacy Rule and HITECH Act Responsibilities of Lash.

With regard to its use and/or disclosure of PHI, Lash agrees to:

  • Use and/or disclose the PHI only as permitted or required by these Terms of Use or as otherwise permitted or Required by Law.
  • Report to you, in writing, any use and/or disclosure of the PHI that is not permitted or required by these Terms of Use of which Lash becomes aware within fifteen (15) days of Lash becoming aware of such unauthorized use and/or disclosure.
  • Establish procedures for mitigating, to the extent practicable, any deleterious effects from any improper use and/or disclosure of PHI that Lash reports to you.
  • Use commercially reasonable efforts and safeguards to maintain the security of the PHI and to prevent unauthorized use and/or disclosure of such PHI.
  • Require all of its subcontractors and agents that receive or use, or have access to, PHI under these Terms of Use to agree, in writing, to adhere to the same restrictions and conditions on the use and/or disclosure of PHI and other restrictions and requirements that relate to PHI that apply to Lash pursuant to these Terms of Use.
  • Make available all records, books, agreements, policies and procedures relating to the use and/or disclosure of PHI to the Secretary of the Department of Health & Human Services ("HHS") for purposes of determining your compliance with HIPAA, subject to attorney-client and other applicable legal privileges.
  • Within fifteen (15) days of receiving a written request from you, make available during normal business hours at Lash's offices all records, books, agreements, policies and procedures relating to the use and/or disclosure of PHI to you for the purposes of enabling you to determine Lash's compliance with the terms of these Terms of Use.
  • Within fifteen (15) days of receiving a written request from you, provide to you such information as is reasonably requested by you to permit you to respond to a request by an Individual to inspect and obtain a copy of PHI about the Individual that is maintained in a Designated Record Set, for as long as the PHI is maintained in the Designated Record Set; to amend PHI or a record about the Individual in a Designated Record Set, for as long as PHI is maintained in the Designated Record Set; and for an accounting of the disclosures of the Individual's PHI.
  • Disclose to its subcontractors, agents or other third parties, and request from you, only the minimum PHI necessary to perform or fulfill a specific function required or permitted hereunder.

Security Rule and HITECH Act Responsibilities of Lash.

With regard to its use and/or disclosure of ePHI, Lash agrees to:

  • Implement Administrative, Physical and Technical safeguards that reasonably and appropriately protect the Confidentiality, Integrity and Availability of the ePHI that it creates, receives, maintains or transmits for or on behalf of you pursuant to these Terms of Use.
  • Ensure that any agent, including a subcontractor, to whom it provides such ePHI agrees to implement reasonable and appropriate safeguards to protect it.
  • Report to you any Security Incident of which it becomes aware that involves the Confidentiality, Integrity or Availability of the ePHI that it creates, receives, maintains or transmits for or on behalf of you, provided, however, that trivial, non-material attempts to penetrate Lash's networks or systems that occur on a daily basis, such as scans, "pings" or other unsuccessful attempts to penetrate such computer networks or systems, will not be reported.
  • Authorize termination of these Terms of Use by you if you reasonably determine that Lash has violated a material term of these Terms of Use.

Breach Notification Rule Responsibilities of Lash

To the extent Lash accesses, maintains, retains, modifies, records, stores, destroys or otherwise holds, uses or discloses Unsecured PHI, it will, following the discovery of a Breach of such information, notify you within fifteen (15) days of such Breach. Any such notice will include, to the extent possible, the identification of each Individual whose Unsecured PHI has been, or is reasonably believed by Lash, to have been accessed, acquired or disclosed during such Breach. Lash will also provide to you other available information that you are required to include in your notification to the Individual.

Additional HIPAA and HITECH Act Provisions.

You shall notify Lash, in writing, of any arrangements between you and an individual that is the subject of PHI that may impact in any manner the use and/or disclosure of that PHI by Lash under these Terms of Use.

You may immediately terminate these Terms of Use if you determine that Lash has breached a material term of these Terms of Use and if Lash has failed to cure the violation within thirty (30) days of written notice from you. If you have breached a material terms of these Terms of Use and if you have failed to cure the violation within thirty (30) days of written notice from Lash, Lash may immediately terminate these Terms of Use, cease providing the e-Patient Management Services to you and report you to the Secretary of HHS.

Upon the event of termination pursuant to these Terms of Use, Lash agrees to return or destroy all PHI to you if it is feasible to do so. Prior to doing so, Lash further agrees to recover any PHI in the possession of its subcontractors or agents. If it is not feasible for Lash to return or destroy said PHI, Lash will extend any and all protections, limitations and restrictions contained in these Terms of Use to Lash's use and/or disclosure of any PHI retained after the termination of these Terms of Use, and to limit any further uses and/or disclosures to the purposes that make the return or destruction of the PHI infeasible. If it is infeasible for Lash to obtain, from a subcontractor or agent any PHI in the possession of the subcontractor or agent, Lash will require its subcontractors and agents to agree to extend any and all protections, limitations and restrictions contained in these Terms of Use to the subcontractors' and/or agents' use and/or disclosure of any PHI retained after the termination of these Terms of Use, and to limit any further uses and/or disclosures to the purposes that make the return or destruction of the PHI infeasible.


Non-identifiable Data and How We Use It

This Site also collects non-identifiable data including web logs, pages visited, operating systems, and web browser type (Windows, Safari, Mozilla, Safari, etc.) and version. This Site also uses cookies when you visit to help recognize and track non-personal information, including your internet service provider. The log information cookies do not collect any personal information.


Personal information

This Site collects personally identifiable information (including PHI) and uses and discloses it to perform the services described in these Terms of Use and to facilitate requests from you. It does not otherwise use personally identifiable information.

Except with respect to personally identifiable information, any communication or material that you transmit to, or post on, the Site by electronic mail or otherwise, including any data, questions, comments, suggestions, or the like, is, and will be treated as, nonconfidential and nonproprietary information, and neither Allergan nor Lash shall have any obligation of any kind with respect to such information. Allergan, Lash and any of our affiliates may use such information for any purpose whatsoever, including, but not limited to, reproduction, disclosure, transmission, publication, broadcast, and further posting. Further, Allergan, Lash and any of our affiliates shall be free to use such information, including, but not limited to, any ideas, concepts, know-how, or techniques contained therein, for any purpose whatsoever, including, but not limited to, researching, developing, manufacturing, and marketing products incorporating such information.


Countries

The Site and its contents are intended for use by licensed physicians (and their staff) within the United States.


Links

This Web site may contain links to other Web sites. Allergan is not responsible for and does not control the contents or performance of such Web sites, and accepts no responsibility for the consequences of your use thereof.


Indemnity

You agree to indemnify and hold Allergan, Lash, other third party service providers, and our respective affiliates, officers, directors, employees and agents harmless from and against any third party claim, action or demand and all liabilities and settlements related thereto, including without limitation, reasonable legal and accounting fees (including defense costs), resulting from, or alleged to result from, a breach of these Terms of Use or your use of the Site or its services.


Forward-Looking Statements

The Site may contain information that is forward-looking and involve risks and uncertainties, including, without limitation, risks and uncertainties of research and development, clinical development, regulatory approvals, our reliance on third-party manufacturers, product commercialization, competition, patents, product liability, and third-party reimbursement, and other risks and uncertainties detailed from time to time in Allergan's periodic reports filed with the Securities and Exchange Commission. Actual results may differ from the forward-looking information.


Jurisdiction and Venue

These Terms of Use will be governed by the laws of the State of California, without respect to its conflict of laws provisions and that venue with respect to any dispute between you and Allergan or Lash will rest exclusively in the state or federal courts located in Orange County or San Francisco County, California.


Miscellaneous

The Terms of Use constitute the entire agreement between you and Allergan and Lash relating to the Site. There is no agency, partnership or joint venture relationship between any user and Allergan or Lash arising solely through the use of the Site. The Terms of Use are binding upon your successors, assigns, heirs and executors. If any provision of the Terms of Use is found to be invalid by any court having competent jurisdiction, the invalidity of such provision shall not affect the validity of the remaining provisions of the Terms and Conditions, which shall remain in full force and effect. The failure of any party to exercise or enforce any right or provision of the Terms of Use shall not constitute a waiver of such right or condition. Any claim or cause of action arising out of or related to the Site or the Terms of Use must be filed within one year after such claim or cause of action arose. The section titles of these Terms of Use are merely for convenience and will not have any effect on the substantive meaning of these Terms of Use.


Other Disclosures

Upper Limb Spasticity
BOTOX® for injection is indicated for the treatment of upper limb spasticity in adult patients to decrease the severity of increased muscle tone in elbow flexors (biceps), wrist flexors (flexor carpi radialis and flexor carpi ulnaris), and finger flexors (flexor digitorum profundus and flexor digitorum sublimis).

Important Limitations
Safety and effectiveness of BOTOX® have not been established for the treatment of other upper limb muscle groups, or for the treatment of lower limb spasticity. Safety and effectiveness of BOTOX® have not been established for the treatment of spasticity in pediatric patients under age 18 years. BOTOX® has not been shown to improve upper extremity functional abilities, or range of motion at a joint affected by a fixed contracture. Treatment with BOTOX® is not intended to substitute for usual standard of care rehabilitation regimens.

Cervical Dystonia
BOTOX® is indicated for the treatment of adults with cervical dystonia to reduce the severity of abnormal head position and neck pain associated with cervical dystonia.

Blepharospasm and Strabismus
BOTOX® is indicated for the treatment of strabismus and blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age and above.

Primary Axillary Hyperhidrosis
BOTOX® is indicated for the treatment of severe primary axillary hyperhidrosis that is inadequately managed with topical agents.

IMPORTANT SAFETY INFORMATION

Distant Spread of Toxin Effect
Postmarketing reports indicate that the effects of BOTOX and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have underlying conditions that would predispose them to these symptoms. In unapproved uses, including spasticity in children, and in approved indications, cases of spread of effect have been reported at doses comparable to those used to treat cervical dystonia and at lower doses.

CONTRAINDICATIONS

BOTOX® is contraindicated in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation.

WARNINGS AND PRECAUTIONS

Lack of Interchangeability Between Botulinum Toxin Products
The potency Units of BOTOX® are specific to the preparation and assay method utilized. They are not interchangeable with other preparations of botulinum toxin products and, therefore, Units of biological activity of BOTOX® cannot be compared to or converted into Units of any other botulinum toxin products assessed with any other specific assay method.

Spread of Toxin Effect
See Boxed Warning.

Hypersensitivity Reactions
Serious and/or immediate hypersensitivity reactions have been reported. These reactions include anaphylaxis, serum sickness, urticaria, soft-tissue edema, and dyspnea. If such a reaction occurs, further injection of BOTOX® should be discontinued and appropriate medical therapy immediately instituted. One fatal case of anaphylaxis has been reported in which lidocaine was used as the diluent, and consequently the causal agent cannot be reliably determined.

Pre-Existing Neuromuscular Disorders
Individuals with peripheral motor neuropathic diseases, amyotrophic lateral sclerosis, or neuromuscular junctional disorders (eg, myasthenia gravis or Lambert-Eaton syndrome) should be monitored particularly closely when given botulinum toxin. Patients with neuromuscular disorders may be at increased risk of clinically significant effects including severe dysphagia and respiratory compromise from typical doses of BOTOX®.

ADVERSE REACTIONS
The following adverse reactions to BOTOX® for injection are discussed in greater detail in the following sections: Spread of Toxin Effect (see Boxed Warning); Hypersensitivity Reactions (see Contraindications and Warnings and Precautions);

Post Marketing Experience
There have been spontaneous reports of death, sometimes associated with dysphagia, pneumonia, and/or other significant debility or anaphylaxis, after treatment with botulinum toxin. There have also been reports of adverse events involving the cardiovascular system, including arrhythmia and myocardial infarction, some with fatal outcomes. Some of these patients had risk factors including cardiovascular disease. The exact relationship of these events to the botulinum toxin injection has not been established.

Please see BOTOX® full prescribing information, including Medication Guide

CPT is a registered trademark of the American Medical Association.

The information on this site is intended for US healthcare providers only.
No information in this site is provided with the intention to give medical advice or instructions on the accurate use of Allergan products.
Allergan cannot answer unsolicited e-mails requesting personal medical advice; visitors should always consult a healthcare professional.